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Diagnosis and treatment of patients with delirium

Macquarie University

Grant:
  • Early-Mid Career Fellowship
Date Funded:
  • 1 February, 2017
Chief Investigator/s:
  • Dr. Virginia Mumford

Delirium, a transient confusional state, is an increasing problem for Australia’s ageing inpatient demographic. Incidence rates from international studies range between 3-29 per cent for patients over 65 years, equivalent to 116,731 – 1,128,400 inpatients using Australian 2013-14 admissions data.

Higher rates of 47-63 per cent have been observed in surgical patients over 65 years, and critically ill patients with delirium have substantially higher prevalence rates (up to 70 per cent) and longer hospital stays (by 6.5 days). Delirium has a significant health impact as inpatients developing delirium are 2.6 times more likely to die during admission, and have a higher risk of developing dementia (adjusted relative risk of 5.7, CI 1.3-24.0). The presence of pre-existing dementia increases the risk of developing delirium two to five times.

A key factor for this research is that delirium is largely preventable, using evidence based guidelines for implementing pharmaceutical, physical, and care delivery changes to inpatient care. The Australian Commission for Safety and Quality in Health Care is releasing a new Delirium Clinical Care Standard (Standard) in 2016 which incorporates this multi-component approach. This is therefore a critical time to investigate and evaluate the impact and effect size of implementing the new Standard, whether the Standard is being implemented as planned, and whether the Standard is effectively addressing the need to identify, prevent and treat delirium.

This study will provide critical data for assessing the benefits to patients and cost-savings gained through preventing and treating delirium in a rapidly ageing population, using a novel combination of applied health economic and implementation science principles. Delirium incidence rates in study hospitals will be measured before, and after, the implementation of the multi-component intervention that forms the basis of the Standard. In addition to standardised clinical outcomes, the study will assess barriers and enablers to the implementation and provide vital feedback to policy makers to understand and improve translation of the evidence based guidelines into practice. Despite existing research on the design of the multi-component interventions, the financial impact of delirium to the health system, and effectiveness of interventions for clinical outcomes, the unique contribution of this study is in determining the cost-effectiveness of these multi-component interventions in Australian acute care and the factors that ensure success.